Attaching unit costs to Australia's National Survey of Mental Health and Wellbeing

Background: In mental health, policy-makers and planners are increasingly being asked to set priorities. This means that health economists, health services researchers and clinical investigators are being called upon to work together to define and measure costs. Typically, these researchers take available service utilisation data and convert them to costs, using a range of assumptions. There are inefficiencies, as individual groups of researchers frequently repeat essentially similar exercises in achieving this end. There are clearly areas where shared or common investment in the development of statistical software syntax, analytical frameworks and other resources could maximise the use of data. Aims of the Study: This paper reports on an Australian project in which we calculated unit costs for mental health admissions and community encounters. In reporting on these calculations, our purpose is to make the data and the resources associated with them publicly available to researchers interested in conducting economic analyses, and allow them to copy, distribute and modify them, providing that all copies and modifications are available under the same terms and conditions (i.e., in accordance with the 'Copyleft' principle), Within this context, the objectives of the paper are to: (i) introduce the 'Copyleft' principle; (ii) provide an overview of the methodology we employed to derive the unit costs; (iii) present the unit costs themselves; and (iv) examine the total and mean costs for a range of single and comorbid conditions, as an example of the kind of question that the unit cost data can be used to address. Method: We took relevant data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), and developed a set of unit costs for inpatient and community encounters. We then examined total and mean costs for a range of single and comorbid conditions. Results: We present the unit costs for mental health admissions and mental health community contacts. Our example, which explored the association between comorbidity and total and mean costs, suggested that comorbidly occurring conditions cost more than conditions which occur on their own. Discussion: Our unit costs, and the materials associated with them, have been published in a freely available form governed by a provision termed 'Copyleft'. They provide a valuable resource for researchers wanting to explore economic questions in mental health. Implications for Health Policies: Our unit costs provide an important resource to inform economic debate in mental health in Australia, particularly in the area of priority-setting. In the past, such debate has largely, been based on opinion. Our unit costs provide the underpinning to strengthen the evidence-base of this debate. Implications for Further Research: We would encourage other Australian researchers to make use of our unit costs in order to foster comparability across studies. We would also encourage Australian and international researchers to adopt the 'Copyleft' principle in equivalent circumstances. Furthermore, we suggest that the provision of 'Copyleft'-contingent funding to support the development of enabling resources for researchers should be considered in the planning of future large-scale collaborative survey work, both in Australia and overseas.

Using special events to motivate visitors to attend art galleries

The contemporary directions of art galleries worldwide are changing as social patterns and demands, as well as visitor expectations of their experiences at art galleries, change. New programs and strategies are being developed in galleries to make these institutions more appealing to people who would not normally visit them, and one such strategy is the staging of special events. However, because galleries are staging an increasing number of special events, the factors motivating visitors to attend these institutions are changing. Visitors hope to have different experiences and encounters in the gallery during special events. This paper presents the findings from a study in Australia about visitors’ motivations to attend special events in galleries. It highlights the different factors that motivate visitors to attend the gallery specifically for a special event in comparison to visiting the gallery's permanent collections.

Customer emotions in service failure and recovery encounters

Emotions play a significant role in the workplace, and considerable attention has been given to the study of employee emotions. Customers also play a central function in organizations, but much less is known about customer emotions. This chapter reviews the growing literature on customer emotions in employee–customer interfaces with a focus on service failure and recovery encounters, where emotions are heightened. It highlights emerging themes and key findings, addresses the measurement, modeling, and management of customer emotions, and identifies future research streams. Attention is given to emotional contagion, relationships between affective and cognitive processes, customer anger, customer rage, and individual differences.

Reconciliation through communication in intercultural encounters: potential or peril?

As we reflect on the events of September 11th and their aftermath, there is strong motivation in many places to improve intercultural and international relations through communication. This laudable aim implicates the long history of research into intercultural encounters, which has always bad this goal. To achieve it, researchers and trainers must go beyond conceptualizing intercultural encounters as like interpersonal ones, except that participants have different and sometimes conflicting cultural rules and values. We must develop programs to train metaskills in analyzing miscommunication and its negative consequences. This requires the recognition that, in many interethnic and intercultural contexts, participants are not. motivated to communicate well. In such cases, the larger sociopolitical situation must be addressed, or skills training may even exacerbate the conflict. It is also crucial to understand intercultural communication as simultaneously intergroup and interpersonal, to incorporate both aspects into interventions, and to advocate for such training to improve intercultural relations.

Alternatives to peace keeping in Korea: the role of non-state actors and face-to-face encounters

Korea is one of the world's most volatile areas, not least because traditional UN mediation and peacekeeping missions are impossible. Having intervened in the Korean War on behalf of the southern side, the UN is a party to the conflict, rather than a neutral arbiter. The situation is particularly problematic because political interactions are characterized by a high degree of state-control over security policy. In both parts of the peninsula the state has, at least until recently, exercised the exclusive right to deal with the opponent on the other side of the hermetically divided peninsula. Given these domestic and international constrains, alternative approaches to conflict resolution are urgently needed. The recently proliferating literature on human security offers possible solutions, for it urges policy makers to view security beyond the conventional military-based defence of the state and its territory. Using such a conceptual framework, the essay assesses the potential significance non-state interactions between North and South, particularly those that promote communication, information exchange and face-to-face encounters. Even though these interactions remain limited, they are of crucial importance, for they provide an opportunity to reduce the stereotypical threat images that continue to fuel conflict on the peninsula.

(FAB11_2_003) Authentic Japanese architecture after Bruno Taut: the problem of eclecticism

This paper will examine attitudes to eclectic stylistic borrowing in Japan in the twentieth century in light of the concept of authenticity. I am particularly interested in how an earlier claim correlating European modernist and traditional Japanese architecture continues to colour conceptions about what is an 'authentic' response for Japanese architects to make to contemporary conditions. Non-Western and vernacular architectures generally have been the repository for touristic desires for regional authenticity and difference. Yet Japan's unique role in the development of modernist architecture has given a peculiar intensity to the demand for its architecture to resist a perceived postmodern decadence.

Expression of the iron regulatory peptide hepcidin is reduced in patients with chronic liver disease

Disturbances in iron metabolism often accompany liver disease in humans and hepatic iron deposition is a frequent finding. Since the peptide hepcidin, a major regulator of body iron homeostasis, is synthesised in the liver, alterations in hepcidin expression could be responsible for these effects. To investigate this possibility, we studied hepcidin expression in liver biopsies from patients with hepatitis C virus (HCV) infection, non-alcoholic fatty liver disease (NAFLD) and hemochromatosis (HC). Total RNA was extracted from the liver tissue of 24 HCV, 17 NASH and 5 HC patients, and 17 liver transplant donors (controls). The levels of mRNA for hepcidin and several other molecules involved in iron metabolism (DMT1, Dcytb, hephaestin, ferroportin, TfR1, TfR2, HFE and HJV) were examined by ribonuclease protection assay and expressed relative to the housekeeping gene GAPDH. The expression of hepcidin was significantly decreased in HCV and NASH patients relative to control liver (109±16 and 200±44 versus 325±26 respectively; P=0.008 and 0.02). We have previously reported similar findings in patients with HC, and this was confirmed in the current analysis (176±21; P=0.003). In both HCV and NAFLD patients the expression of the iron reductase Dcytb and the transferrin binding regulatory molecule TfR2 was also decreased, while the cellular iron exporter ferroportin showed a significant increase. Levels of the mRNA for the iron oxidase hephaestin were lower in HCV patients alone, while expression of the major transferrin binding molecule TfR1 was decreased only in NAFLD patients. Of particular interest was the finding that the expression of HJV (which is mutated in patients with juvenile HC) was significantly increased in NAFLD patients. No changes were seen in the expression of the iron importer DMT1 or the regulatory molecule HFE. Decreased expression of hepcidin in patients with HCV and NAFLD provides an explanation why iron homeostasis could be perturbed in these disorders. Reduced hepcidin levels would increase intestinal iron absorption and iron release from macrophages, which could contribute to hepatic iron accumulation. This in turn could lead to alterations in the expression of various proteins involved in iron transport and its regulation. Indeed most of the changes in the expression of such molecules observed in this study are consistent with this. However, the mechanisms leading to changes in the expression of hepcidin in these diseases remain to be elucidated.

Spatial bias and temporal lag in tactile space perception

Constructing a veridical spatial map by touch poses at least two problems for a perceptual system. First, as the hand is moved through space, the locations of features may be displaced if there is an uncorrected lag between the moment the hand encounters a feature and the time that feature is encoded on a spatial map. Second, due to the sequential nature of the process, some form of memory, which itself may be subject to spatial distortions, is required for integration of spatial samples. We investigated these issues using a task involving active haptic exploration with a stylus swept back and forth in the horizontal plane at the wrist. Remembered locations of tactile targets were shifted towards the medial axis of the forearm, suggesting a central tendency in haptic spatial memory, while evidence for a displacement of perceived locations in the direction of sweep motion was consistent with processing delays.